ALBANY, N.Y. (NEWS10) — The nation’s largest long-term care workers union now calls on New York State to make new standards and hold private nursing home companies accountable following the NYS Attorney General investigation into nursing homes COVID response. Both the union and its members say the report just confirms what they already claim to know — the system is broken and has been for a long time.
“The conditions that existed prior to the pandemic, not only were exposed, but it was shown how they were exacerbated,” says Milly Silva, 1199SEIU Executive Vice President.
Silva says 1199SEIU just launched a new campaign titled “Invest in Quality Care.” It focuses on raising public awareness of what Silva calls the shortfalls in the long-term care industry, and the campaign also encourages those it reaches to contact legislators.
“There’s no going back to the ‘normal’ if the ‘normal’ before the pandemic was that we had an industry where excessive profits have been pulled from the system instead of those resources being directed towards care and towards the workforce, and so residents don’t get the care that they need,” asserts Silva.
The AG’s report details how problems like low staffing prior to the pandemic were made significantly worse as the pandemic hit. Linda Johnson has worked at The Diamond Nursing and Rehabilitation Center for around 15 years. She says her facility that once operated as a “well-oiled machine” quickly became overwhelmed.
“We are constantly doing the best we can for our residents, but it is disheartening and I would say depressing because it’s never enough,” Johnson explains in a phone call with NEWS10’s Mikhaela Singleton. “Nurses left, they got scared number one. Number two, the workload was enormous, and then people started to get sick with COVID, so we were even more short-staffed.”
She says prior to the pandemic, there would be at least one LPN such as herself, and up to four aides in every ward. However, now she says they can barely keep their heads above water.
“It used to be the standard we would never have more than 20 people assigned to each of us, and I would say that’s challenging but still pretty manageable for running trays and checking up on people. However, now there’s maybe only two aides and a nurse to every ward, so right now I’m assigned to around 27 people, and that’s a lot to handle,” she explains.
“I’ve heard stories where there’s only one staff member assigned to 40 people,” says Silva. “We have to look at where New York State is at and involve the workers and the families and the residents and facilities into the conversation with lawmakers to come up with other ways to safeguard the quality of care residents need, and frankly deserve.”
Silva says the “Invest in Quality Care” campaign calls for better compensation and benefits, minimum staffing requirements for any long-term care facility, and a minimum number of hours each resident receives individualized care. She goes on to say New York is one of the few states without such requirements already in place.
A release by the 1199SEIU says New York is one of only 10 states without a minimum staffing requirement and ranks 45th in the nation for average care hours per resident day. In contrast, Vermont has required at least three nursing care hours per resident day since 2001. Starting in 2000, California law required all nursing homes provide at least 3.2 nursing care hours per resident day, then the state increased again to 4.1 hours in 2016.
“Healthcare advocates and experts certainly recommend at least 4.1 hours per day. That is what research and policy has shown in terms of a gold standard for nursing home care,” Silva says.
“I would love to be able to really look at my patients and know them in and out like that and be able to give care like that,” says Nurse Johnson.
However, those who speak on behalf of facilities do not agree. The New York State Health Facilities Association and NYS Center for Assisted Living represent more than 400 long-term care facilities in New York State, and they claim state mandates wouldn’t solve anything.
“There is no one-size-fits-all approach to providing care to men and women in nursing homes, they need to be assessed individually based on their level of mobility, dependency for certain tasks, and their medical requirements,” says President and CEO Stephen Hanse.
Hanse says setting minimum nursing care hours per day would first require the staff, and adds the national personnel shortage before the pandemic should serve as an indicator.
“There are not enough nurses in the state of New York to meet the needs. Consider before the pandemic, we had a strong economy and still folks were choosing other careers outside of long-term care. Then the pandemic presented itself and created its own, even greater staffing shortage,” Hanse says.
Silva agrees there is a lack of qualified personnel and nursing homes are finding trouble hiring; however, she says that’s why 1199’s campaign also calls for a wage increase and full disclosure on how state funding is used.
“There are taxpayer dollars through Medicaid and Medicare that are allocated towards providing care in our nursing homes, but what is happening is that we have an industry that is not required to spend a certain percentage of those resources towards direct care,” she explains.
An ad by 1199 describes a practice where nursing homes can spend state and federal funds to subcontract services like food and laundry to smaller businesses the corporation also owns, thus keeping profits within the company.
“If stakeholders and our lawmakers in Albany were to require that nursing homes have to spend a majority percentage of those resources that they’re allocated on direct care, that would — we believe — significantly impact what care at the bedside looks like and keep that money in the system where it belongs to go towards hiring and resources for staff,” Silva says.
When asked if there was any truth to Silva and 1199’s explanation, Hanse says it is “hardly a common practice.”
“What you see could be dealing with economies of scale, so if a nursing home has a food service business and that business provides the food to the residents, well then those are two separate legal entities, but that service is still going directly to the residents. I would say that’s still fairly transparent for things of that nature,” Hanse says.
He also says the amount of Medicare and Medicaid funding most private nursing homes receive isn’t enough to keep pace with 1199’s demands, or even existing operating costs.
“A nursing home on average in New York State is paid $211 per day to care for a resident for 24 hours of care, and that includes staff, food, everything. Staffing costs are already 70 percent of operating costs. If you take that $211 for a 24 hour period, the state reimbursement for nursing home care is actually $8.79 per hour to care for each resident, that is woefully short,” Hanse explains.
He says even to hire the additional staff needed to accommodate a minimum nursing care hours per resident day standard, it would collectively cost nursing homes about $2 billion.
“New York State is already in a $15 billion deficit. A better course of action would be for the state to allocate funds to encourage men and women to enter the long-term care fields and put a stop to the Medicare and Medicaid cuts that have passed in the New York State budget for the last 12 years, even in the middle of the pandemic,” he says.
“The fundamental issue is that the state really needs to treat nursing homes as an investment and not as an expense, I believe we and 1199 agree on that,” Hanse goes on to say.